Laparoscopic Redo Hepatico-jejunostomy for Biliary Stricture After Open Hepaticojejunostomy for Cbd Injury

Introduction:This video illustrates the key aspects of laparoscopic redo hepatico-jejunostomy (HJ) for anastomotic biliary stricture. We present the case of a 43 year-old female who was referred to us after an open HJ for a CBD injury during laparoscopic cholecystectomy. The patient was found to have a biliary stricture and developed multiple episodes of cholangitis. The patient had a failed attempt of percutaneous transhepatic dilatation due to the inability to pass the guide-wire through the anastomosis. The transhepatic cholangiogram revealed a very tight stricture of the anastomosis.Methods and Procedures:A laparoscopic redo hepatico-jejunostomy was performed with the patient in the split-leg position. The hepatico-jejunostomy and, then, the CBD were exposed after extensive lysis of adhesions. After the anastomosis was taken down, the small segment of stenosed biliary duct was resected and the hepatico-jejunostomy reconstructed without tension by using two 4/0-Monocryl running sutures. Results:The patient tolerated well the procedure. She was discharged home on postop day 3 uneventfully. Conclusion:We conclude that laparoscopic redo hepatico-jejunostomy after the same open procedure performed for CBD injury is a safe and a feasible alternative to percutaneous transhepatic or transjejunal dilation with or without stenting.